After successfully demonstrating the feasibility of virtual reality cue exposure (VRCE) for smoking in a phase I trial, we proposed to develop a virtual reality skills training (VRST) treatment for nicotine dependence based on traditional cognitive behavioral coping skills programs. VRST combines computer graphics with sensory input devices including: tracking devices, visual head mounted displays (HMD), and directional audio designed to immerse a participant in a computer-generated virtual environment. VRST for nicotine dependence will combine the elements of VR with specific drug cues, environments, drug related social interactions, and other associated stimuli in the safe, confidential and controlled lab or office treatment setting. VRST combining video images and exposure to complex cues will expand traditional cue-exposure (reactivity) approaches and will offer distinct advantages over traditional treatment approaches. This project focuses on the development of seven additional VRST scenarios combining both computer generated and video images depicting smoking cues (e.g. cigarette packages, ash trays, burning cigarette) and smoking social interactions (e.g. being offered a cigarette in a social context, riding in a car with a smoker, approaching a building entrance where people are smoking). In addition, a VRST treatment manual will be developed. The feasibility and efficacy of VRST will be tested in a clinical pilot study with cigarette smokers. One hundred nicotine dependent smokers recruited from and urban inner city asthma clinic and will be randomized to either VRST + nicotine replacement therapy (NRT) or NRT only (NRTO). A ten week treatment trial will compare VRST+NRT versus NRTO on cigarette consumption, co-levels, and cessation rates across treatment and follow up (1, 2, 3, & 6 months) time periods. In addition, all participants will be assessed for cue reactivity (craving and physiological) at baseline, week 4 and week 10 using VRCE. The overarching aim of this project is to develop and test VRST cessation approach for nicotine dependent cigarette smokers. The long-term goal is to develop and test the VRST, and develop affordable turnkey, VRST systems that will be commercially available to substance abuse programs, individual therapists, hospitals, and drug addiction researchers for nicotine and other drugs of abuse.